Can Patients With IUGR and Abnormal Umbilical Artery Dopplers Safely Undergo Induction of Labor?

Author Type(s)

Faculty

Document Type

Abstract

Publication Date

2-2021

DOI

10.1016/j.ajog.2020.12.193

Journal Title

American Journal of Obstetrics and Gynecology

Department

Obstetrics and Gynecology

Abstract

Objective

To compare the difference in fetal outcomes in 3 groups of pregnancies affected by intrauterine growth restriction (IUGR) and abnormal umbilical artery (UA) Dopplers: those who underwent cesarean delivery without labor, those who underwent intrapartum cesarean delivery, and those who underwent a vaginal delivery following a successful induction of labor.

Study Design

A retrospective cohort study of 125 pregnancies affected by IUGR and abnormal UA Dopplers. Eighty-one underwent cesarean delivery without labor. Twenty-six had a successful induction while 18 underwent intrapartum cesarean delivery. Maternal and neonatal demographics and outcomes were collected and compared. The primary outcomes were neonatal APGARs <7 at 5 minutes of life, fetal acidosis at birth (arterial cord pH <7.2), Birth weight and NICU admission. Secondary outcomes were indication for delivery, preeclampsia with severe features and gestational age at time of delivery

Results

There were no differences in NICU admissions, APGAR scores <7 at 5 minutes of life and rates of fetal acidosis, even when adjusted for degree of UA abnormality and maternal age. Interval fetal growth of >100g / 2 weeks prior to delivery, favorable bishop score, younger maternal age, and a later gestational age at time of IUGR diagnosis were associated with higher rates of successful induction of labor (p=0.001, p<0.001, p=0.004, p=0.002). Higher birth weight and a lower incidence of preeclampsia with severe features were more common in the group that underwent successful induction of labor (p <0.001, Beta coefficient 0.55, 0.23-0.88 95% CI, p=0.003 OR 0.07, 95% CI 0.01-0.51).

Conclusion

There was no difference in neonatal outcomes in those patients who underwent induction of labor compared to those who underwent scheduled cesarean delivery in pregnancies affected by IUGR and abnormal UA doppler regardless of severity of UA doppler abnormality.

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